Can Anxiety and Panic Disorder Cause Depression if Left Untreated?

Mental health problems are infamously complicated. Although psychologists have a successful guidebook to identify and diagnose mental illness, those manuals are merely suggestions for treatment — and can’t predict exactly how you experience your psychological and emotional well-being. With that in mind, some people experience multiple forms of mental health disorders, often in various degrees. If somebody has several mental health conditions, it’s known as “comorbidity,” and anxiety and depression are the two most related diagnoses.

What Is Anxiety?

Anxiety is a sense of unease, for instance, worry or concern, which might be mild or severe. Additionally, it is the primary symptom of panic disorder. All of us have feelings of anxiety at some stage in our life. For instance you may feel nervous and worried about taking an exam, having medical testing done, or a job interview. During times such as these, experiencing anxiousness can be perfectly normal. However, many individuals struggle to manage constant worry. Their feelings of anxiety tend to be more frequent and can influence their everyday life.

What Is Depression?

Feeling depressed generally is a typical response to loss, life challenges, or wounded self-esteem. However, when feelings of extreme sadness, which includes hopelessness and worthlessness, continue for a number of days to weeks and keep you from functioning normally, your feelings could be something more than sadness. It could possibly be major depressive disorder.

Anxiety disorder and depression frequently manifest together. They have similar symptoms which can be hard to tell apart. Either can result in frustration, insomnia, not being able to focus, and worry.

Untreated anxiety and panic disorder can raise your potential for more serious conditions. These conditions include depression, drug abuse, and suicide.

Anxiety disorder doesn’t just influence emotional well-being. This common disorder could be intense enough to result in or aggravate headaches, gastrointestinal syndromes, abnormal heart rhythms and sleep disorders.

The link between depression and anxiety is so powerful that some antidepressants are used to address people who don’t have depression and are alternatively living with anxiety disorders. Anxiety coping strategies are often recommended for people with depression, even when the individual doesn’t suffer from anxiety. Other studies have also revealed that the same neurotransmitters might also lead to both anxiety and depression.

Depression can develop due to anxious thoughts. This seems to be particularly true of those with panic disorder, possibly since panic attacks tend to trigger feelings of fear, helplessness, and disaster. Furthermore, those coping with anxiety may not be living the life they had dreamed of and this reinforces feelings of powerlessness or loss which can ultimately lead to depression.

Many people who have anxiety and/or depression assume that treatment for these disorders may not be effective — that if you have previously tried therapy or medication without much relief, then nothing can be done for you. But it is simply not true. It may take time and effort, but don’t stop until you find the right treatment.

Current studies suggest that treatment should start with addressing depression first. A decrease in depressive symptoms often means a reduction of anxiety symptoms as well. Also, some common and efficient prescription drugs for depression hold the added bonus of decreasing anxiety.

To recover, you’ll need to be as relentless, invasive and powerful as the depression and anxiety. You are unique and treatment can be complex, but freedom from depression and anxiety is possible.

Do not let your anxiety and/or depression go untreated.

If you are experiencing chronic and unexplained feelings of anxiousness, fear, or worry, sadness or suicidal thoughts, schedule an appointment with your doctor immediately.

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Book Review: Hunger

Roxane Gay is the brilliant author of the New York Times bestseller, Bad Feminist. She holds a prestigious position as a contributing opinion writer for the New York Times. She’s a novelist, a short-story writer, a professor, and a voice that untold numbers of devoted fans clamor to hear. She comes from a close, loving family of thin, stylish, and accomplished Haitian immigrants.

She is also “super morbidly obese,” an actual official category that includes people who are three or four hundred pounds overweight. Her new book Hunger is her riveting memoir of life as a fat person.

“No matter what I accomplish,” writes Gay, “I will be fat, first and foremost.”

Each of the eighty-eight chapters of Hunger are short. Gay’s writing style seems to say: I’m telling you this story straight. I’m not going to dance around it.

Roxane Gay wishes she had told her life-shattering story a very long time ago.

At age 12, when she was little and cute, her boyfriend brought her out to a remote cabin where he and his friends gang-raped her. She wishes she had shared her account with her family, her friends, or anyone else who would have listened and told her that it was not her fault and that she was not alone.

“I don’t want to be defined by the worst thing that has happened to me,” Gay tells us. “At the same time, I don’t want to be silent.”

She also does not welcome the predictable responses to stories like hers.

“I do not want pity or appreciation or advice. I am not brave or heroic. I am not strong. I am not special,” she writes. The real travesty, she notes, is that the experience of having been raped is “utterly common.”

“I began eating to change my body… Some boys had destroyed me, and I barely survived it. I knew I wouldn’t be able to endure another such violation, and so I ate because I thought that if my body became repulsive, I could keep men away,” writes Gay

Now, decades later, Gay hungers for a different, smaller body. She’s tried in many ways to achieve that, but like everyone else who is overweight, she is up against powerful biological, physiological, and psychological forces that make significant and lasting weight loss unlikely. Gay does not point to those impediments. Hunger is not a book of excuses.

It is not surprising that people can be insensitive, presumptuous, and cruel toward those who are fat. Still, the stories are shocking. For example, when Gay was in boarding school, a resident faculty member imitated her “in a game of charades by widening her arms and waddling around the room” until someone guessed her name. In supermarkets, strangers remove from her shopping cart items they don’t think she should have.

“I have gone to an emergency care facility for a sore throat and watched as the doctor wrote, in the diagnosis section, first, ‘morbid obesity’ and, second, ‘strep throat,’” writes Gay.

To people who are fat, the most ordinary tasks of everyday life such as walking, fitting into seats in restaurants and airplanes, and finding clothes that fit are a challenge. The psychological trials — such as the withering gaze of others, and trying to enjoy a meal in public without judgment — make things harder.

Writers of the most successful television series are masters at the art of the cliffhanger, and some authors are very skilled in this art too, ending each chapter in such a way that readers just can’t help turning the page to the next. But Hunger has no cliffhangers. It doesn’t need them. The writing, the thinking, the insights, and the story are all so compelling that no verbal gymnastics are necessary – readers just keep on reading.

Hunger is not, as Gay cautions at the outset, the standard tale of triumph over adversity, with the author emerging at the end as her newly thin self. But Hunger is a triumph of a different sort. Gay wrestled the story of her body back from those who would tell it for her. She tells her own story in her own way. It is a unique story. And, in its humanity, it is also universal.

Hunger: A Memoir of (My) Body
Harper, June 2017
Hardcover, 307 pages

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Depressed & Suicidal Thoughts

I’m a 25yo male, i’ve been diagnosed with depression with suicidal thoughts more than one year ago and i’m still struggling with it, i’ve started receiving medical treatment since may 2016 now, during this period i’ve been prescribed with Dosulepin, Escitalopram, Fluvoxamine, and Sertraline respectively for one month for each but none of them affected me in a good way. And finalyi’ve been on Fluoxetine for 7 months now and still no any improvement at all. I’ve recently came across an article stating that depression can be caused by some hormonal deficiency so i’ve made a list of most related hormones to the problem and got blood tested for them and the results were as following:
TSH:2.23 uIU/ml. (Biological Reference: 0.3 – 4.8)
Testosterone Free: 17.0 pg/ml. (Biological Reference: 8.3 – 40.1)
Follicle Stimulating Hormone (FSH): 2.6 mIU/ml. (Biological Reference: 1.5 – 12.4)
Luteinizing Hormone (LH): 7.1 mIU/ml. (Biological Reference: Adult: 1.7-8.6)
Prolactin: 14.0 ng/ml. (Biological Reference: 4 – 15.2)
Estradiol (E2): 5 pg/ml. (Biological Reference: 7.6 – 43)
Progesterone: 0.4 ng/ml. (Biological ReferenceAdult: 0.2 1.4)
Testosterone-Total: 4.62 ng/ml. (Biological Reference: Adult : 2.4 – 8.3)
Cortisol-am: 19.25 ug/dL. (Biological Reference: 6 – 19.4)
Cortisol-pm: 21.21 ug/dL. (Biological Reference: 2.3 – 11.9)
Parathyroid Hormone (PTH): 55.2pg/ml. (Biological Reference: 15 – 65)
I’ve stopped seeing any doctors and i’m about to give up trying tbh and i don’t have the power to go find a new good doctor and start the whole journey again with him/her..
Do you think that my tests results indicate a physical problem that can be the cause of the whole depression problem? and what would you recommend me to do next?

A. I would highly recommend counseling. You are assuming that depression is a biological or hormonal problem, but there are other theories. Not living a meaningful life, making the wrong choices, substance abuse, trauma, poor parenting, are potential causes or contributors. The fact that multiple theories exist suggests that the exact cause of depression remains elusive.

Research shows that depression is highly responsive to talk therapy. Cognitive behavioral therapy (CBT) has been particularly effective in treating depression. It targets thinking errors which are often associated with depression.

It would be premature for you to stop seeking help when you have yet to try the first-line treatment for depression. Your next step should be to find a psychotherapist who treats depression. In the United States, many individuals begin their search for a good therapist by reading reviews on the Internet, contacting their insurance company or by asking their primary care physician for a referral. You should choose a therapist who has a proven track record in helping patients overcome depression. I recommend calling and interviewing at least five therapists. Ask them questions about how they’ve helped other people and how they would specifically help you. The therapist with whom you feel the most comfortable and with whom you have the strongest connection will likely be your best choice.

I would also encourage you to read about depression. Some of my favorite books about the topic are written by Abraham Maslow, Viktor Frankl and David Burns.

Medication might help you to overcome depression, but it rarely works on its own. You should add counseling to your treatment regime. Perhaps the two would help to relieve your suffering. Thanks for your question. Good luck.

Dr. Kristina Randle

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Depressed & Suicidal Thoughts

I’m a 25yo male, i’ve been diagnosed with depression with suicidal thoughts more than one year ago and i’m still struggling with it, i’ve started receiving medical treatment since may 2016 now, during this period i’ve been prescribed with Dosulepin, Escitalopram, Fluvoxamine, and Sertraline respectively for one month for each but none of them affected me in a good way. And finalyi’ve been on Fluoxetine for 7 months now and still no any improvement at all. I’ve recently came across an article stating that depression can be caused by some hormonal deficiency so i’ve made a list of most related hormones to the problem and got blood tested for them and the results were as following:
TSH:2.23 uIU/ml. (Biological Reference: 0.3 – 4.8)
Testosterone Free: 17.0 pg/ml. (Biological Reference: 8.3 – 40.1)
Follicle Stimulating Hormone (FSH): 2.6 mIU/ml. (Biological Reference: 1.5 – 12.4)
Luteinizing Hormone (LH): 7.1 mIU/ml. (Biological Reference: Adult: 1.7-8.6)
Prolactin: 14.0 ng/ml. (Biological Reference: 4 – 15.2)
Estradiol (E2): 5 pg/ml. (Biological Reference: 7.6 – 43)
Progesterone: 0.4 ng/ml. (Biological ReferenceAdult: 0.2 1.4)
Testosterone-Total: 4.62 ng/ml. (Biological Reference: Adult : 2.4 – 8.3)
Cortisol-am: 19.25 ug/dL. (Biological Reference: 6 – 19.4)
Cortisol-pm: 21.21 ug/dL. (Biological Reference: 2.3 – 11.9)
Parathyroid Hormone (PTH): 55.2pg/ml. (Biological Reference: 15 – 65)
I’ve stopped seeing any doctors and i’m about to give up trying tbh and i don’t have the power to go find a new good doctor and start the whole journey again with him/her..
Do you think that my tests results indicate a physical problem that can be the cause of the whole depression problem? and what would you recommend me to do next?

A. I would highly recommend counseling. You are assuming that depression is a biological or hormonal problem, but there are other theories. Not living a meaningful life, making the wrong choices, substance abuse, trauma, poor parenting, are potential causes or contributors. The fact that multiple theories exist suggests that the exact cause of depression remains elusive.

Research shows that depression is highly responsive to talk therapy. Cognitive behavioral therapy (CBT) has been particularly effective in treating depression. It targets thinking errors which are often associated with depression.

It would be premature for you to stop seeking help when you have yet to try the first-line treatment for depression. Your next step should be to find a psychotherapist who treats depression. In the United States, many individuals begin their search for a good therapist by reading reviews on the Internet, contacting their insurance company or by asking their primary care physician for a referral. You should choose a therapist who has a proven track record in helping patients overcome depression. I recommend calling and interviewing at least five therapists. Ask them questions about how they’ve helped other people and how they would specifically help you. The therapist with whom you feel the most comfortable and with whom you have the strongest connection will likely be your best choice.

I would also encourage you to read about depression. Some of my favorite books about the topic are written by Abraham Maslow, Viktor Frankl and David Burns.

Medication might help you to overcome depression, but it rarely works on its own. You should add counseling to your treatment regime. Perhaps the two would help to relieve your suffering. Thanks for your question. Good luck.

Dr. Kristina Randle

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Book Review: Crazy-Stressed

“If you think your teen is more stressed, anxious, and depressed than you were back in your teen day, you’re right. If you think that’s because he’s lazy and weak or self-centered and spoiled, you’re wrong,” writes Dr. Michael Bradley in his new book Crazy-Stressed: Saving Today’s Overwhelmed Kids With Love, Laughter, and the Science of Resilience.

According to Bradley, kids today are in trouble, but this is because the world has changed. While that may sound like grim news, it is also a powerful reminder to parents that successfully raising a teenager today requires a kind of resilience-focused parenting that helps teens cope with the challenges they will face.

Comparing today’s teens to those of fifty years ago–according to the work of Jean Twenge of San Diego State University and her peers–anxiety and depression rates among teenagers are up by as much as 500 percent. One kid in every six has thought about or tried to commit suicide, and the majority of teens do not feel that their world is in their control.

But parents today also spend much more time disabling their kids with excessive care-taking, according to Bradley. As a result, kids today are a lot more self-centered. To confirm this assertion, Bradley points to the work of psychologist Michael Borba, who shows that kids are 40 percent less empathic and 60 percent more self-centered than they were thirty years ago.

Teens today grow up in a technology-saturated world where, thanks to social media, they maintain a much larger public perception than their parents did in their adolescence. They are more likely to be the subject of cyberbullying, to become addicted to a screen, and to have trouble focusing. They are also more likely to struggle with desensitization, aggression, sexual dysfunction, sleep disturbance, and weight management. While they turn to marijuana and alcohol more often, the form of marijuana they consume is significantly more potent than what their parents may have used in adolescence. While teens may be attempting to insulate themselves from the stressors they face, drugs in particular actually decrease resilience.

“First, regular use essentially freezes the social/emotional levels of young teens through the very years when they are supposed to do their greatest growth. Second, since the drugs do anesthetize the worry, the worrier never gets stronger because she doesn’t go through the critical resilience-building exercise called standing up to the stress and coping,” writes Bradley.

And while impulsive, reactive, and moody teenage brains often result in parents who over-control and excessively vie for power, reckless behavior in adolescence is not unexpected.

“…Our kids are supposed to do this stuff we hate. Like it or not, this is Mother Nature’s way, forcing the rebirth of your child, a second breaking away process you cannot and should not want to stop any more than you could or would the first such process,” writes Bradley.

Much of the reason for this, Bradley says, is that developing resilience requires exposure to difficult and scary things in graduated doses. Unlike what many people believe, resilience is not inherited; rather it can be built and developed just like a muscle.

Building resilience begins with allowing teens some autonomy to choose their activities, along with a little rope to make mistakes. Over time, this allows teens to develop a feeling of competence. Bradley says parents should also praise their teens for efforts rather than outcomes, and characterize mistakes as essential components of learning.

Connection is one the most important parts of resilience, and can be developed when parents make the home a secure base, allow for their teens full range of emotional expression, and express love even when they are upset. By modeling good behavior, morals and values, as well as taking time to discuss meaning and purpose with teens, parents help teens develop character. By acknowledging their successes, and linking autonomy with responsibility, parents can help their teens develop self-control–a core component of resilience.

Parents can also model how to cope with stressors, contribute to the world, and engage in community, all of which can help build resilience in teens.

But resilience-parenting also requires an adept set of skills, Bradley notes. For example, parents should “discipline smart” by separating punishment from consequences,  and “talk smart” by choosing the timing for important discussions wisely. Parents should ask more questions than they offer answers, listen fully, stay connected, and think about ways to incorporate resilience into other parenting choices.

What parents should avoid, Bradley cautions, is taking teens’ behavior personally, making decisions while angry, trying to handle a serious drug problem without qualified help, allowing unsupervised screen access before 14, and underestimating the effects of excessive stress.

With disarming charm, clear-headed advice, and a tool chest of skills parents can use with their teen immediately, Bradley offers parents an invaluable resource in today’s overwhelming (and overstressed) world–the gift of resilience.

Crazy-Stressed: Saving Today’s Overwhelmed Teens With Love, Laughter, and the Science of Resilience
Dr. Michael J. Bradley
Amacom Books (2017)
Softcover
243 Pages

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3 Things that Keep Us Lonely

As a psychotherapist, I frequently observe how lonely and isolated people feel. Although they may be married or successful in their career, people often report a painful sense of disconnection or alienation.

Although there are varied reasons for experiencing a sense of isolation, here are three things I’ve noticed that may contribute to the epidemic of loneliness in our society.

Being Critical of Others

John Gottman’s research into what makes partnerships thrive has highlighted how criticism is one factor that leads to breakups (along with contempt, stonewalling, and defensiveness).

Pointing out someone’s perceived flaws is usually experienced as hurtful. Many of us have grown up with painful criticism, which is toxic to well-being. Feeling criticized in our adult life may trigger a storehouse of pain that makes us want to withdraw. Or we may react to criticism by lashing out at the person who has criticized us. Attacking or withdrawing keeps us isolated and shuts down the potential for intimacy.

As we become more mindful of when we’re being critical, we can notice the feelings and unmet needs that underlie our criticisms. Instead of telling our partner with a sharp tone of voice that he is unavailable or that their work is more important than our relationship, we can reveal our loneliness and perhaps take a risk to ask for a hug — or a heartfelt conversation.

As we replace criticism with a more vulnerable expression of our tender feelings, we’re more likely to draw our partner and other people toward us.

Shaming People

Criticism is toxic because it triggers shame. Many of us grew up with a gnawing sense that something is wrong with us. When someone criticizes us, we may revert back to the hurt child — the one who can never do anything right. Shame is an extraordinarily painful emotion. When it gets triggered, we find ways to not feel it.

Bret Lyon, PhD, and Sheila Rubin, LMFT, who lead workshops on Healing Shame, describe shame as a form of trauma. Our impulse is to avoid it by shutting down — or we shift our shame to the other person, blaming them and making them feel badly. Lyon describes how shame is like a hot potato. We want to pass it on to the one who shamed us or transfer our shame to another person. This shame-transference is a reflection of the shame we carry inside and don’t want to feel.

Shame aversion — the refusal to feel any shame and work with it skillfully — is responsible for much of our isolation. Instead of allowing ourselves to notice when it arises, we push it away or dissociate from it because it feels so threatening; it dysregulates our nervous system.

Rather than sinking into shame and getting overwhelmed by it, we can notice it, allow it some space, and realize that shame has arisen in us, but that we are not the shame.

Believing We Should Be Perfect

The desire to be perfect has an insidious way of keeping us constrained and isolated. Perfectionism is often driven by shame and fear. We cling to the notion (usually unconscious) that if we can be perfect in our words and actions, then no one can shame or criticize us; rejection won’t hurt as much if we don’t make ourselves vulnerable.

Realizing that we are imperfect might prevent us from taking risks to connect with people. We hide our true feelings and desires, fearful that if we expose them we’d be rejected or humiliated. Our intention is to protect ourselves from pain, but keeping ourselves hidden increases a painful sense of isolation.

As we find more inner strength, we realize that it’s ok to have human flaws. We can accept and love ourselves, despite how people respond to us. We have no control over how others perceive us. But we do have control over how we hold and view ourselves — hopefully with respect and dignity, despite our shortcomings.

The failure to accept our imperfections may lead to stonewalling behavior, which Gottman identifies as another factor that leads to divorce. We hesitate to engage in authentic, meaningful conversations because we’re afraid that we’ll fail — or that it will make things worse. It’s safer to refuse to talk when our partner wants to discuss our relationship. We may find it more interesting to retreat to the computer room or watch television than have a soulful conversation.

Realizing that we don’t have to be perfect may inspire us to have more authentic communication with our partner or friends. Simply listening with an open heart can help us feel less isolated. Deeper connections can happen in our life by offering the gift of non-defensive listening.

We can find more meaning and richness in our relationships as we take the risk to be more vulnerable — revealing our authentic feelings rather than attacking or shaming people. We can live a less lonely existence as we let go of the isolating belief that if we can’t say or do something perfectly, then don’t say or do it.

We often experience the same thing that others feel but don’t express. The loneliness you may feel is rampant in our society. By taking to risk to engage with people — whether through your smile, your humor, or sharing your true feelings — you take a step toward healing your isolation. At the same time, you may be offering a gift that helps others feel less isolated, too.

If you like my article, please consider viewing my Facebook page and books below.

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How A Person’s Face Signals Intention To Cheat On You

Face shape is linked to sex drive in men and women and also how likely a man is to cheat on his partner. 

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8 Small Shifts that Significantly Enhance Your Life

Sometimes, we need to make big changes in our lives. We need to take a different job. We need to sell our home and downsize. We need to move to a different city. We need to end a relationship.

And sometimes the smallest shifts can help. Sometimes adjusting our perspective can have a significant impact. Sometimes adopting a small habit can drastically improve our days. Below are eight habits and perspective-shifters to try, which might even be life-changing.

Surround yourself with positive voices. “You become the five voices you are around the most,” said Brooke Schmidt, a marriage and family therapist who owns Arrow Therapy in Eden Prairie, Minn. Which is why she stressed the importance of paying attention to the people around you, the books and blogs you’re reading, the videos you’re watching and the words you’re listening to. “Are you around a lot of negative or fear-based voices, or are you around people and things you find uplifting and energizing?”

Relinquish regrets. How many times a day do you berate yourself for a decision you made months ago? Years ago? “Many of us spend time rehashing past decisions and blaming ourselves for our choices,” said Ryan Howes, Ph.D, a clinical psychologist and writer in Pasadena, Calif.

But how does this make sense? Because when we made the decision, we didn’t have the information we have now. At the time, you didn’t know that your partner would turn out to be a narcissist. You didn’t know that you’d lose your job or that the housing market would crash. Which is why Howes suggested giving “your former self a break and [accepting] that you had your best interests in mind, you were using all the tools you had, and you made your choice based on the best information you had at the time.”

Of course, you might want to identify if there are any lessons to be learned, such as “waiting for more data or keeping impulses in check.” But in general, it’s best to forgive yourself and move on. Howes teaches his clients to repeat this mantra: “I made the best decision with the information I had at the time.”

Re-evaluate your priorities and values. “Take 5 minutes to jot down the things that you spend the most time on (your priorities) and the activities and people in your life that are most important to you (your values),” said Elizabeth Gillette, LCSW, an attachment-focused therapist in Asheville, N.C., who specializes in working with individuals and couples as their families grow. This “can help clarify areas of your life that don’t feel in alignment.”

You might not be able to change certain activities or responsibilities—such as the length of your commute—but you can make it feel as valuable as possible, she said. For instance, if your commute involves taking the bus or train, you can read your favorite kinds of books, journal or knit. If you drive, you can listen to podcasts or audiobooks. You can take long, deep breaths at every red light.

Tackle tiny, tangible tasks. Since it’s easy to feel overwhelmed and paralyzed by our to-do lists, Howes recommended performing a small, simple task to gain some momentum. This might be anything from making your bed to making a call to paying a bill to taking a walk. He’s found that making progress on such tasks inspires us to scratch off other items, which might’ve paralyzed us earlier.

Take regular pauses. Gillette encourages her clients to set alarms on their phones as reminders to take 1- to 2-minute breaks throughout their day. During this time, you might take deep breaths—four counts in, and four counts out—or cross your arms over your chest and tap alternately on each shoulder, she said.

“This very short break allows all parts of our brain to integrate information and provide our nervous system a much-needed rest from external input.”

Another restorative option is to turn off your phone and put it in a drawer for at least 15 minutes, she said.

Adopt a curious perspective. “People can make a huge change in their outlook on life if they adopt a stance of curiosity instead of leaping to conclusions or reacting impulsively,” Howes said. He shared this example: You and your partner planned to go to the beach for the weekend. But your partner suddenly wants to stay home. You might want to scream, “What?! You always cancel our plans!”

Instead, you get curious. Instead, you observe what’s happening and ask a thoughtful question, without judgment or accusations: “Hmmm. I thought our plan was to go to the beach. Have you changed your mind about that? Why?” This kind of dialogue leads to a discussion (versus a fight). And “you could learn valuable information about your partner and how they approach problems.”

Refocus on your inherent worth. We tend to attach our self-worth to objects and accomplishments. And when we don’t attain them, we tend to put ourselves in a less-than position. For instance, your friend gets new furniture for their entire house, which makes you think that you can’t have anyone over because your furniture isn’t as nice, Schmidt said. Your coworker gets promoted, which makes you think that you’re not good enough to move up, she said. Remind yourself regularly that “this stuff does not define your worth or value as a person.”

Celebrate your actions. “Many people set their criteria for success impossibly high—so high that they base it on factors that are beyond their control,” Howes said. For instance, if you ask someone out and they say no, you probably consider it a failure. After all, you got rejected. But this is an action to celebrate. Because, as Howes said, you overcame the fear of asking someone out and put your best foot forward. Whether the other person is interested depends on myriad factors, all of which you have zero control over, including their relationship status, interest level or mood that day, he said.

In another example, a woman requests a raise. Even though she’s anxious, she does her research and rehearses her talk. But she’s turned down. “Has she failed?” Howes said. “No. She was victorious over the fear and anxiety as soon as she made her request, and deserves to revel in that victory.” She can’t control whether the company is going bankrupt or whether they have a strict policy on raises, he said.

We can’t measure our success based on factors we can’t control. All we can control is our ability to show up and do our homework. And those are vital things to celebrate.

Often we don’t need to overhaul our lives to see and savor meaningful benefits. The above suggestions are great examples of this.

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The 3 Main Types of Exhaustion

“I’m so exhausted,” Stephanie said as she sat down on her therapist’s couch. “I can’t seem to get a grip on my life.” As she began to recount the events over the past few days, her exhaustion was pervasive at work and home. She overreacted to a missed appointment with threats of firing her assistant. She nearly drove another car off the interstate after being cut-off earlier. And she forgot about her daughter’s dance recital. Her life seemed to be unraveling at the seams.

Exhaustion is real. It is a warning indicator that something is not right and needs immediate attention. When the empty fuel indicator lights up on a car, a person stops and refuels. If they don’t, the car eventually runs out of gas and shuts off. The body works the same way. Problematic exhaustion can led to a physical, mental, and emotional breakdowns.

• Physical Exhaustion. This is probably the most recognizable type of exhaustion as the body seems to have a hard time gaining benefits from any type of rest. Some relaxation is needed daily, weekly, monthly and annually. For instance, the body naturally requires sleep daily. But instead of this being beneficial, the reverse happens as increased sleep only produces more exhaustion the next day.
  • Causes: Typically, the body needs 8 hours of sleep a day, one day off a week, another holiday within a month or so, and two weeks of vacation a year. These designated periods of rest allow the body to reset so it is better equipped for days demanding higher performance. When a person fails to properly unwind, the body shuts down as a reminder that this is essential.
  • Solution: A quick glance at a calendar can determine if there is adequate downtime. The most important area to fix first is daily sleep. Without sufficient amounts of the deep rapid eye movement sleep (REMS), a person can appear to have attention-deficit disorder, increased anxiety and irritability, memory problems, weight issues, more confusion, sensitivity to pain, and unnecessary firing of survival instincts (freeze, fight, or flight). Consulting with a sleep expert to discover any potential sleep disturbances is essential to recovery.
• Mental Exhaustion. “I can’t seem to think through things like before,” is a common indicator of mental exhaustion. It is as if the reasoning part of the brain is so clouded that even simple decisions become difficult. And this is exactly what is happening. The largest part of the brain is the frontal lobe which controls judgement, problem solving, emotional regulation, personality, motor functioning, memory, and impulse control. When this is exhausted, it stops working properly.
  • Causes: A traumatic brain injury (TBI) or post-traumatic stress disorder (PTSD) are two common causes for mental exhaustion. Depending on the severity of a TBI, the effects can last from a couple of days to a lifetime. PTSD hijacks the proper function of the brain in an effort to self-protect from additional trauma. Long-term unresolved PTSD can create unhealthy brain pathways that become habitual adding to increased difficulty as a person ages.
  • Solution: A thorough neurological examination is essential for recovery of a TBI. The brain can get better with stable routine, adequate rest and nutrition, and utilization of occupational therapy. Recovery from PTSD requires an understanding and reframing of the trauma which is best done in the care of a trained therapist. When these two areas are addressed, the mental exhaustion clears up immediately.
• Emotional Exhaustion. The repeated stuffing of uncomfortable emotions such as anger, sadness, or anxiety results in explosive behavior at a later date. Often, the volcanic eruptions manifest in abusive actions like verbal assaults. An emotionally exhausted person can be so numb that they can no longer feel, might cry uncontrollably without cause, or osculate between the two in a bi-polar like manner. These intense responses are visible to others who are usually at odds with how to help.
  • Causes: Emotions don’t exist in a vacuum. Rather, they have a tendency to collect past experiences and add it to the present in an effort to purge the pent-up feelings. This is especially true for anyone who has experience abuse. There are seven major types of abuse: physical, mental, verbal, emotional, financial, sexual, and spiritual. Unresolved past abuse can resurface even during an otherwise mundane incident. This often looks like a person who makes “a mountain out of a mole hill.”
  • Solution: Defense mechanisms for handling abuse like denial, projection, dissociating, compartmentalization, and rationalization only last so long. Eventually, the trauma resurfaces and hijacks daily functioning. Complete healing from past abuse is possible but it does require perspective from a trained professional. Because feelings of shame are so closely related to past abuse, this area of exhaustion is hypersensitive. But, it does have the greatest impact on the overall functioning of a person.

For Stephanie, her exhaustion was in all three areas. By intentionally tackling one area at a time, she was able to fully recover and function with a full tank of gas instead of constantly running on empty.

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Book Review: This Close to Happy

In the category of memoirs about depression, there are some distinguished contributions. They include, for example, Kay Redfield Jamison’s An Unquiet Mind, William Styron’s Darkness Visible, and Susanna Kaysen’s Girl, Interrupted.

Daphne Merkin knows these books well, but as someone who has dealt with serious depression her entire life, she finds them lacking.

“It seems to me that these characterizations tend to bracket the episodes of breakdown or incapacitating depression within unimpeachable demonstrations of the writer’s otherwise hyperfunctioning existence,” writes Merkin.

With This Close to Happy, Merkin wanted to do something different, to “describe what it feels like to suffer from clinical depression from the inside, in a way that I hope will speak to both the sufferers and the onlookers to that suffering, whether friends or family.”

She succeeds at this brilliantly. To people who have similarly experienced deep depression, not as a bracketed section of their lives but as an enduring theme, the beautifully written This Close to Happy is a gift. To those who would blithely tell people who are seriously depressed to just snap out of it, or look on the bright side, This Close to Happy is a wake-up call.

Daphne Merkin could have arranged the pieces of her life into one of those “unimpeachable demonstrations of the writer’s otherwise hyperfunctioning existence.” She has ascended the heights of literary acclaim, having written as a staff writer for the prestigious The New Yorker. She is an award-winning author and was an editor at Harcourt Brace Jovanovich.

In This Close to Happy, Merkin shares those experiences, as well as the other enticements she tries to grab onto when she is sinking. They include, for example, “the supreme diversion of reading and the gratifications of friendship, the enveloping bond of motherhood and the solace to be found in small pleasures.” But it takes an effort, a monumental effort, and many days that effort is beyond her.

That’s because her depression isn’t bracketed. It is interwoven with the rest of her life. Merkin has been in therapy for more than forty years. She takes copious quantities of prescription drugs. On three separate occasions, she has spent weeks in a psychiatric hospital.

This Close to Happy is about Daphne Merkin’s experiences of being this close to suicide. She wakes up feeling depressed nearly every day. She considers suicide regularly. She talks to herself about it, considers different ways of ending her life, and makes her case to her therapists. Those conversations happen on the good days. Other times, getting to her therapist’s office, talking, and even eating are just too difficult. The effort it takes a seriously depressed person to accomplish the ordinary tasks of everyday life is one of the recurrent themes of the book.

If you have a clinically depressed person in your life, you might not know it, Merkin says. Many depressed people can summon what it takes to put on a happy, sociable face for a dinner party or some other time-limited social occasion. But it is a burden. In fact, in her nuanced discussion of all that is disconcerting about being institutionalized for depression, Merkin underscores one saving grace: There is no need to feign happiness in a psychiatric hospital.

If This Close to Happy were “just” a memoir, it would be immensely valuable. But it is more. The book also offers readable discussions of the social science of depression and suicide, touching on topics such as the prevalence of our maladies in the U.S. and globally, sex differences in depression, and the tendency of depression to run in families. Merkin knows a lot about the varieties of anti-depressant medications and she shares that understanding, too.

Equally intriguing are the sections in which Merkin sails beyond the science to offer her own musings on matters of depression. How much of it, really, is nature, and how much is nurture? Does psychotherapy help? What is it about the stigma of depression that makes it different from the sensibility of, say, addiction or schizophrenia? To what extent are childhood experiences implicated in lasting life difficulties?

Merkin’s childhood was a tangle of contradictions. There was never enough food in the house for the six children. Her mother was stunningly cruel, her father indifferent, and her nanny, cold. But there was a nanny. And a chauffeur, a cook, a cleaning woman and a laundress.

Eventually, Merkin would find skillful psychiatrists and other mental health professionals to help her navigate a life “marooned in misery.” Early on, though, there were many false starts and bad advice. For example, when her mother sought advice for dealing with her daughter’s uncontrollable crying spells, she was told to lock Daphne in a bedroom. She did.

“I once dreamed of conquering my depression for good, but I have come to understand that it is a chronic condition, as much a part of me as my literary bent,” writes Merkin.

Nonetheless, by the end of the book, Merkin really is “this close to happy.” Her readers will be, too.

This Close to Happy: A Reckoning with Depression
Daphne Merkin
FSG, February 2017
Hardcover, 289 pages

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Decreasing Attention Span & Focus

Hi. I’ve always had issues with attention and focus as a child, but I’ve never noticed it and managed to get myself throughout childhood and adolescence without much trouble or difficulty.

However, in the past few years, and particularly the past couple of years, my ability to focus (on studying and other activities requiring sustained mental concentration) have been decreasing at an alarming rate.

I feel that my mind is driven by a “motor” that constantly requires stimulation. I would sit down to study and my thoughts would immediately begin to wander. Suppressing those thoughts would be a near-impossible task for me. It has gotten to the point that I would take roughly twelve (or more) hours to read something that a typical individual could do so in less than forty-five minutes. I have to intentionally drain my cellphone/laptop battery so that they do not distract me, although even those measures fail to maintain my focus.

Since the things I’m studying in school are memorization-heavy and require significant recall abilities, this issue has taken a heavy toll on my academics.

Is there anything I could do to alleviate this issue? I do not wish to use any medications nor do I think I need the consult of a physician.

Thank you! (From Canada)

A:  While it would not be possible nor ethical for me to make a diagnosis, I would say you may want to rule out the possibility of Attention Deficit Hyperactivity Disorder (ADHD) as the symptoms seem to suggest this is at least something to rule out. I’d highly recommend you connect with a licensed clinical psychologist qualified to deliver a battery of tests that can determine your strengths and possible weaknesses. More than that, these evaluations typically recommend treatment options. For more information you may want to read our article at PsychCentral.com.

Wishing you patience and peace,
Dr. Dan

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Psychology Around the Net: September 30, 2017

Ah, the leaves are changing and the air’s getting crisper…goodbye September! I can’t say I’ll miss you (you kind of whizzed right on by?!) and October is my favorite month anyway!

This week’s Psychology Around the Net covers the real psychology behind taking a knee, what really creates the “grit” personality trait, why some people don’t need to hear “I love you” in relationships, and more.

Study Challenges Validity of the Psychological “Grit Scale”: For the past decade or so, various industries, from practical psychology to selecting employees, have used the Grit Scale to help measure a person’s “grit” — a supposed personality trait that combines perseverance to reach goals and consistency in interests. However, a new research shows that while the Grit Scale does measure perseverance and interest, the two components do not form a single trait.

The Psychology of Taking a Knee: When Colin Kaepernick took his first knee, did he realize he was starting a scientific conversation that goes way beyond his reason for the protest?

A Stanford Psychologist on the Art of Avoiding Assholes: You read that correctly: Robert Sutton, a psychology professor at Stanford University, has released The Asshole Survival Guide — seven years after his The No Asshole Rule — and he’s given an interview on everything from what exactly defines an “asshole” to how you can avoid being one.

What New Depression Drug Possibilities Are Out There? Researchers combining certain classes of medications have found these combinations can increase effectiveness, which can help doctors more quickly and efficiently determine which medicines will be the most effective for their patients.

This Photo Is A Powerful Reminder That Mental Illness Isn’t Always Visible: Many of us associate pictures of sad, gloomy-looking people with mental illness; however, there is no single — if any — kind of picture that shows mental disorders, as mental health advocate Milly Smith is trying to tell us. Smith posted a picture of herself looking and feeling happy one morning — and then tried for the third time to commit suicide seven hours later.

Why You Don’t Have To Say “I Love You” To Feel Love: Perhaps the most important thing — as simple as it sounds — is knowing what you want from the relationship and making sure you get it.

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Your Narcissist Friend Probably Isn’t Listening to You

If you can recognize this pattern, you can handle your favorite narcissist more effectively.

One trait of men and women with narcissistic habits makes them frustratingly difficult to deal with — either as a partner at work or someone to live with at home.

As a therapist who specializes in helping couples build more satisfying marriages, I focus on this trait in particular.

What is that habit that most people overlook about narcissists?

Get Familiar With These 20 Styles Of Narcissism

When you interact with a person with narcissistic habits, you need to stay strong. Don’t be aggressive; just strong in self-confidence. Expect to be heard. Keep nicely but confidently putting your comments back out there until you succeed.

Then you never know what might emerge. The most overlooked sign of narcissism may — or may not — melt away!

There are many signs of narcissism, but the most telling but overlooked sign is habitual non-listening.

Narcissistic folks tend to do a lot of talking and very little listening. The narcissist knows best, so why bother listening to what others have to say?

Have you ever spoken with someone who responded to whatever you said by dismissing it? Narcissists brush aside, negate, or deprecate what others say instead of truly listening.

There are 2 tip-offs that give this way:

1. The word “but”: This deletes whatever came before — “But a better way to look at it is…”
2. Voice tone: If the response sounds irritated or deprecating, that’s the sound of unwillingness to listen to what’s valid in what you just said.

You are especially likely to trigger a narcissistic person’s message-deafness if your comment differs from the narcissist’s viewpoint. Narcissistic folks hear the words but block out the meaning, the message of the words they are hearing.

Why do therapists tend to miss the poor listening habits when they are assessing narcissism?

People with narcissistic tendencies do tend to listen to someone they see as higher in power than themselves. If those with narcissistic habits respect their therapist, their listening can appear to their therapist to be quite normal.

If the therapist, by contrast, were to see that same client interacting with his or her spouse or employees, the listening patterns would most likely be glaringly different — dismissive, ignoring altogether, minimizing the importance of the point that the spouse or employee just made, disagreeing with it, and pointing out what was wrong with it.

Most psychologists work with individual clients rather than with couples, so they consequently miss out on seeing the narcissistic listening habits.

Furthermore, another reason why therapists seldom note the narcissistic pattern of dismissive listening is because the Diagnostic and Statistical Manual of Mental Disorders (DSM) lists the factors that therapists use for diagnosing emotional problems and problematic personality patterns.

Alas, this manual makes no mention of listening deficiencies as a diagnostic factor for narcissism, so therapists tend not to look for them.

Again, psychology in general, and even more so the psychiatrists who write the DSM manual, have historically focused primarily on individuals rather than on what those individuals do when they interact with others.

What are some ways that help you deal more effectively with narcissistic dismissive listening?

1. Do Not Take It Personally.

If someone you know talks with minimal listening, first and foremost do not take it personally. Dismissing what you say as wrong or irrelevant says more about that person than it does about you or what you have said.

Just as you would not take personally the limited hearing ability of someone with partial deafness, realize that your narcissistic friend, co-worker, or loved one has a genuine disability.

What Is a Kerouac Narcissist?

2. Repeat What You Said.

Just as you would repeat, perhaps more loudly, what you were trying to say to a deaf person, find ways to repeat, tactfully, the message that you were trying to communicate.

One formula for tactfully repeating a comment that has been brushed aside is first to agree cooperatively with what the narcissist has said. Then, reiterate your prior point. That is, agree, and then add your perspective.

You: The walls in this room are an unusual color of green.

The narcissist: No, they’re not. They’re yellow.

You: Yes, I agree that they are yellowish and at the same time, there’s a lot of green in the yellow, rather like a lime color.

Why are we drawn to narcissistic people?

Narcissists initially can appear to be very attractive. Many narcissistic individuals are good-looking, earn a good living, and are fun to be around.

Women are attracted to male narcissists because they seem powerful, special, and self-confident. Men are attracted to female narcissists who are strikingly beautiful or sexually appealing.

It’s only when narcissists begin to ignore their partner’s concerns and dismiss what their partner says that narcissistic listening disorder becomes a source of relationship tensions.

Watch Dr. W. Keith Campbell discuss the psychology behind narcissism.

Why do we miss the signs of narcissistic listening deficiency earlier in the relationship?

Narcissists do listen to people who seem to more powerful or who have something that they want.

So, when they are courting, they listen very well. It’s only when the relationship feels secure that narcissists relax back into their baseline dismissive listening style.

What can you do if someone you work with or love has a narcissistic non-listening pattern?

If you have chosen someone with narcissistic habits as a life partner or you have to deal at work in an ongoing way with someone who has difficulty listening to you, begin by viewing narcissism as a handicap. In spite of their charisma, narcissists have a genuine listening deficit.

Ratchet up your self-confidence because you’ll need to speak in a way that conveys an inner sense of personal power.

And from that self-confident stance, use collaborative dialogue skills. Show that you have heard your partner’s viewpoint and then persist until you have succeeded in conveying your viewpoint as well.

Praise and affection will also get you everywhere. Narcissistic folks relax and, therefore, listen better when they feel appreciated.

And keep reminding yourself that most narcissists can and do listen, even with empathy, when they experience the person with whom they are talking as having greater power.

What’s the moral of the story?

When you interact with a person with narcissistic habits, you need to stay strong. Don’t be aggressive; just strong in self-confidence. Expect to be heard. Keep nicely but confidently putting your comments back out there until you succeed.

Then you never know what might emerge. The most overlooked sign of narcissism may — or may not — melt away!

This guest article originally appeared on YourTango.com: The Most Overlooked Symptom Of Narcissism.

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I Just Want to Be Alone

From a teen in the U.S.: Lately (and right now) I’ve been having these moments where all I want to do is be alone and do nothing all day. I’m not necessarily sad unless somebody wants to do something with me or just talk which is sort of strange because I’m generally an open person. (For instance, if my family and friends all went on a week long vacation I would be a happy girl).

However, I do notice a mood change that is significantly darker than before. These feelings usually stick with me for a couple days and whenever any of my friends want to do something, I really just don’t want to because I’d rather be by myself. It’s not that I don’t appreciate them (because I do), it’s just that in these moments the only thing that makes me happy is myself.

During this time, I like to do things like go on Tumblr, watch Netflix, sing a little, sleep, and eat food. I’m usually too lazy to be up and doing stuff for more than 30 minutes at a time too. I’m starting to feel bad because these episodes or whatever they are, come at random times and I can’t control it. I sometimes even become mad at my best friend because she’s wondering why I’m not my happy self all the time. I’m genuinely confused as to what is wrong with me.

I’m also very anxious sometimes, but only about getting shot. I feel like I can never trust anybody (except the people I know). For example, I hate getting on elevators or any closed spaces with strangers because I feel like they’re going to whip out a gun and kill me on the spot. The same kind of fear happens when I’m walking down the street, sitting in a public place, taking the trolley, and the list goes on and on.

A: Have you by any chance tracked whether your feelings of depression are in any way correlated with your period? Premenstrual dysphoric disorder (PMDD) causes a woman to have severe depression symptoms, irritability, and tension before menstruation. Once her period starts, the symptoms virtually disappear. I do suggest you find a mood tracker app and see if your symptoms are in line with your periods.

If that’s not it, then you need to see a counselor for an evaluation. I can’t go any further without more information than you could put in a letter.

As for the fears of getting shot: It’s hard to pay attention to the news and not get anxious, especially if you are a sensitive person. In your case, your anxieties are starting to develop into a phobia. For that reason, I again suggest that you see a counselor to help you learn some new skills for managing it.

I wish you well.
Dr. Marie

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I Just Want to Be Alone

From a teen in the U.S.: Lately (and right now) I’ve been having these moments where all I want to do is be alone and do nothing all day. I’m not necessarily sad unless somebody wants to do something with me or just talk which is sort of strange because I’m generally an open person. (For instance, if my family and friends all went on a week long vacation I would be a happy girl).

However, I do notice a mood change that is significantly darker than before. These feelings usually stick with me for a couple days and whenever any of my friends want to do something, I really just don’t want to because I’d rather be by myself. It’s not that I don’t appreciate them (because I do), it’s just that in these moments the only thing that makes me happy is myself.

During this time, I like to do things like go on Tumblr, watch Netflix, sing a little, sleep, and eat food. I’m usually too lazy to be up and doing stuff for more than 30 minutes at a time too. I’m starting to feel bad because these episodes or whatever they are, come at random times and I can’t control it. I sometimes even become mad at my best friend because she’s wondering why I’m not my happy self all the time. I’m genuinely confused as to what is wrong with me.

I’m also very anxious sometimes, but only about getting shot. I feel like I can never trust anybody (except the people I know). For example, I hate getting on elevators or any closed spaces with strangers because I feel like they’re going to whip out a gun and kill me on the spot. The same kind of fear happens when I’m walking down the street, sitting in a public place, taking the trolley, and the list goes on and on.

A: Have you by any chance tracked whether your feelings of depression are in any way correlated with your period? Premenstrual dysphoric disorder (PMDD) causes a woman to have severe depression symptoms, irritability, and tension before menstruation. Once her period starts, the symptoms virtually disappear. I do suggest you find a mood tracker app and see if your symptoms are in line with your periods.

If that’s not it, then you need to see a counselor for an evaluation. I can’t go any further without more information than you could put in a letter.

As for the fears of getting shot: It’s hard to pay attention to the news and not get anxious, especially if you are a sensitive person. In your case, your anxieties are starting to develop into a phobia. For that reason, I again suggest that you see a counselor to help you learn some new skills for managing it.

I wish you well.
Dr. Marie

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Bipolar Disorder: The Typical Symptoms You Should Know

How to tell if someone has bipolar disorder (manic depression).

• Try one of PsyBlog's ebooks, all written by Dr Jeremy Dean:

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5 Core Beliefs That Can Sabotage Patients’ Careers

Have you ever had a patient that came to you with a clear idea of what he or she would like in their career, but just couldn’t seem to make any progress?

Along with relationships, physical health and spiritual concerns, career issues are one of the most common motivations to seek therapy. Most often, concerns about work and money are rooted in core beliefs about success, security and worthiness that are relics of childhood learning.

Whether patients struggle with long-term stuckness, dissatisfaction or underachievement, their core beliefs can act as significant roadblocks to reaching career goals and can radically compromise financial health, too.

Core beliefs are often expressed through actions rather than words. For instance, a patient may not come forth and say that deep down she believes she’s incompetent, but will express this belief through behavior; by not going for the promotion at work, not pushing herself to develop new skills or staying stuck for years in work that doesn’t challenge her.

The following five core beliefs are based on schema theory, which suggests that core beliefs or schemas are developed early in life and carried into our adult lives, where, when triggered, can be intensely painful. The first step to working with core beliefs is to identify them and the ways they show up in clients’ lives.

Core Beliefs

Do you recognize any of these beliefs in your clients?

1.If I can’t do it perfectly, it’s not worth doing.

Clients who struggle with perfectionism, fear of criticism or the vulnerability that comes with making mistakes often find themselves paralyzed. They may put off starting a new project or learning a new skill until they believe that they can execute it perfectly, which tends to result in failure to start at all.  Clients with this core belief are so averse to the thought of failure that they’d prefer to stay stuck in unchallenging situations, which can severely limit career satisfaction.

While “perfectionis” clients may be high achievers at some point in their lives, they may struggle with self-compassion and relaxation, and instead may instead be highly self-critical and hyperactive.

Highly self-critical clients often operate under the assumption that their inner critic is protecting them, and that if they were to “go easy” on themselves, their performance would surely suffer. But research has shown that self-criticism does not actually motivate improved performance. If anything, it leads to increased burnout and depleted resilience.

2. I’ll never accomplish my goals anyway. Why bother?

We’ve all worked with patients who struggle with excessive negative thinking and ruminative thought patterns. Somewhere along the line, these individuals’ brains shifted to focus almost exclusively on disappointment, loss and all that could go wrong in a situation rather than make space for the possibility that things could go right.

Patients who carry excessive negative core beliefs may have learned early on that the world is a dangerous, unforgiving and disappointing place. They may have even grown up with an anxious, depressed or agoraphobic parent. Because these people are so fixated on failure and on what could potentially go wrong, they tend to stay stuck in situations that range from unsatisfying to toxic for much longer than they should.

3. Others’ needs are more important than my own.

Clients who chronically put the needs of others before their own tend to sacrifice their own wants and needs for the wants and needs of others and can get caught in situations that do not serve them because of guilt, shame or a simple inability to attend to personal needs. Such clients may have grown up with a narcissistic or alcoholic parent or otherwise learned to focus on the needs of others from an early age.

For these clients, boundaries are typically non-existent and the idea of paying attention to one’s own needs over those of others will often come with feelings of selfishness, guilt and even intense fear.

4. I know what I want, but I can never seem to make it happen.

While some patients struggle to even know what they want, others seem to have crystal clear visions of the work they’d like to do and the careers they’d like to have. They simply lack the discipline to make it happen.

Lack of discipline often reflects a lack of distress tolerance, diminished impulse control and a need for instant gratification rooted in an inability to sit with difficult thoughts, feelings or bodily sensations.

The good news is that impulse control can be developed through a mindfulness-based practice called urge-surfing, in which the client learns to notice his or her urges as they arise, and let them pass rather than acting on them.

5. I’m incompetent or possess a fatal flaw that makes success virtually impossible for me.

People who carry the core belief that they are incompetent or possess an irredeemable flaw may have grown up with a highly critical, emotionally neglectful or enmeshed parent.

Emotionally neglectful parents often mean well, but lack understanding of their child’s emotional needs and are unable to tend to them in appropriate ways. As a result, the child learns that there is something deeply wrong with him or her, and carries that belief into adulthood.

Enmeshed parents, on the other hand, blur the boundaries between themselves and their child, hampering the child’s developing sense of self and instilling the belief that the child cannot handle the world on his or her own without the parent.

For those whose core beliefs include that they are incompetent or somehow broken, taking career risks or volunteering for challenging projects each come with the risk that the incompetence or fatal flaw will be exposed. Without addressing the validity of one’s believed incompetence or brokenness, it will be very challenging to take the risks that career success requires.

 

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Medical Marijuana for Depression, Bipolar Disorder, Anxiety & Mental Illness: Can It Help?

The usefulness of medical marijuana for the treatment of mental illness and disorders such as depression, bipolar disorder, anxiety, and schizophrenia is an open question today. There have been only a few really good studies on this issue, and their findings are decidedly mixed.

So let’s dive into the question and see if medical marijuana can help the symptoms of mental illness, or is it more likely to cause harm?

The reason this is a very complex issue is because, unlike medical marijuana for chronic, debilitating pain, there’s a lot of additional factors that must be taken into account when studying mental illness and a psychoactive substance like marijuana. We’re just going to examine marijuana for the use of depression, anxiety, and bipolar symptoms in this article, because those are the populations that have had the greatest number of research studies done.

Marijuana for Depression & Anxiety

Here’s what one recent study found when combing the recent research literature to better understand it:

Results from studies that have focused on recreational users and/or young adults are quite variable; some show a negative association between marijuana use and anxiety/depression (e.g., Denson & Earleywine, 2006; Sethi et al., 1986; Stewart, Karp, Pihl, & Peterson, 1997), others a positive association (e.g., Bonn-Miller, Zvolensky, Leen-Feldner, Feldner, & Yartz, 2005; Hayatbakhsh et al., 2007; Scholes-Balog, Hemphill, Patton, & Toumbourou, 2013), and still others no association (e.g., Green & Ritter, 2000; Musty & Kaback, 1995). Such a diverse pattern of results suggests that other factors may also interact with marijuana use to affect anxiety and depression. (Grunberg et al., 2015).

That’s a fair amount of research — but none of it really conclusive, and much of it contradictory.

That is characteristic of this area of research — complicated, with results often at odds with other research.

These researchers examined 375 University of Colorado students over a 3-year period to track their marijuana use, as well as depression and anxiety symptoms. They also understood that the complexity of human behavior requires a more nuanced approached to an analysis of marijuana use. “The temperament dimension of harm avoidance (HA) is particularly relevant for understanding anxiety and depression as it is characterized by heightened apprehension, shyness, pessimism, and inhibition of behaviors. Given these biases, it is not surprising that HA is positively associated with both anxiety and depression.” So the researchers ensured they also measured temperament.¹

It is also important to consider that the simple relations we observed between marijuana use and depression symptoms differed from those obtained in the more complex models. That is, when only marijuana use was considered, results suggest a positive association between marijuana use and depression. […] [Ed. – This means that greater marijuana use was correlated with greater depressive symptoms.]

However, in the regression models that prospectively predict anxiety/depression and also include [multiple personality factors and temperament] interactions, and baseline anxiety or depression, marijuana use was not an independent predictor of depression symptoms. Moreover, in the models involving [novelty seeking], marijuana use negatively predicted depression symptoms (and anxiety).

These differing patterns of results first demonstrate the importance of measuring the effects of marijuana within the context of other factors known to affect anxiety and depression, as well as prior symptoms of anxiety and depression. The results might also indicate a complex causal relation between marijuana use and depression in which initial symptoms of depression facilitate marijuana use, which subsequently decreases depression (Grunberg et al., 2015).

As you can see, if you simply measure marijuana use and depressive or anxiety symptoms, you might walk away from your study believing that the two share some sort of causal relationship. But as Grunberg et al. found, when you dive deeper into patient histories and personality factors — especially temperament — that relationship goes away. And, in fact, marijuana use might actually help improve depressive symptoms.

What Happens When You Don’t Take the Complexity of These Disorders into Account?

One such study that didn’t look into personality factors or temperament was conducted more recently by Bahorik et al. (2017). As they note, “Marijuana is frequently used by those with depression, yet whether its use contributes to significant barriers to recovery in this population has been understudied.” That’s very true.

So the researchers examined the marijuana use and depression and anxiety symptoms of 307 psychiatry outpatients with depression; assessed at baseline, 3-, and 6-months on symptom (PHQ-9 and GAD-7), functioning (SF-12) and past-month marijuana use for a substance use intervention trial.

What they found was that a considerable number of patients used marijuana within 30-days of baseline — just slightly over 40%. What else did they find? “Depression symptoms contributed to increased marijuana use over the follow-up, and those aged 50+ increased their marijuana use compared to the youngest age group. Marijuana use worsened depression and anxiety symptoms; marijuana use led to poorer mental health functioning.” In addition, they found — surprisingly — that medical marijuana was associated with poorer physical health functioning.²

The researchers concluded that, “marijuana use is common and associated with poor recovery among psychiatry outpatients with depression. Assessing for marijuana use and considering its use in light of its impact on depression recovery may help improve outcomes (Bahorik et al., 2017).”

What about Marijuana for Bipolar Disorder?

Another study looked at the benefits and drawbacks of marijuana for bipolar disorder, because it is the most widely used illicit substance by people with this disorder. Does it help (or hurt) not only symptoms associated with bipolar I disorder, but also cognitive functioning?

The study consisted of 74 adults: 12 with bipolar disorder who smoke marijuana (MJBP), 18 bipolar patients who do not smoke (BP), 23 marijuana smokers without other Axis 1 pathology (MJ), and 21 healthy controls (HC), all of whom completed a neuropsychological battery. Participants also rated their mood 3 times daily, as well as after each instance of marijuana use over a 4 week period.

The researchers found that although the three groups each exhibited some degree of cognitive impairment relative to healthy controls, no significant differences between the two bipolar disorder-diagnosed groups were apparent, providing no evidence of an additive negative impact of bipolar disorder and marijuana use on one’s thinking abilities.

Additionally, the mood ratings indicated alleviation of mood symptoms in the MJBP group after marijuana use; MJBP participants experienced a substantial decrease in a composite measure of mood symptoms. As the researchers note, “Findings suggest that for some bipolar patients, marijuana may result in partial alleviation of clinical symptoms. Moreover, this improvement is not at the expense of additional cognitive impairment” (Sagar et al., 2016).

This research actually helps support previous research conducted by Gruber et al. in 2012. In their study of 43 adults, they found “Significant mood improvement was observed in the MJBP group on a range of clinical scales after smoking MJ […] Notably, total mood disturbance, a composite of the Profile of Mood States, was significantly reduced in the MJBP group” (Gruber et al., 2012).

They concluded:

Further, while the MJBP group reported generally worse mood ratings than the bipolar group prior to smoking marijuana, they demonstrated improvement on several scales post-marijuana use as compared to bipolar, non-marijuana participants. These data provide empirical support for anecdotal reports that marijuana acts to alleviate mood-related symptoms in at least a subset of bipolar patients and underscore the importance of examining marijuana use in this population. (Gruber et al., 2012).

So Does Marijuana Help with Depression, Anxiety, & Bipolar Disorder?

The data is decidedly mixed, and it’s not at all clear whether marijuana would help someone with a mental health condition or not. I suspect that, in the end, it would come down to an individual’s unique reaction, similar to how each individual reacts differently to different psychiatric medications. Well-done research studies seem to indicate that marijuana would help certain people, while it may not help others. But how to determine which group you fall into remains an exercise for future research.

It may be a few more years before we have a more concrete understanding of the benefits and drawbacks of medical marijuana for mental disorders. Until then, you could try it if you feel comfortable doing so, but as always, you should consult your medical or mental health professional before trying any treatment.

 

References

Bahorik, Amber L.; Leibowitz, Amy; Sterling, Stacy A.; Travis, Adam; Weisner, Constance; Satre, Derek D. (2017). Patterns of marijuana use among psychiatry patients with depression and its impact on recovery. Journal of Affective Disorders, 213, 168-171.

Grunberg, Victoria A.; Cordova, Kismet A.; Bidwell, L. Cinnamon; Ito, Tiffany A. (2015). Can marijuana make it better? Prospective effects of marijuana and temperament on risk for anxiety and depression. Psychology of Addictive Behaviors, 29, Special Section: Marijuana Legalization: Emerging Research on Use, Health, and Treatment. 590-602.

Gruber, Staci A.; Sagar, Kelly A.; Dahlgren, Mary K.; Olson, David P.; Centorrino, Franca; Lukas, Scott E. (2012). Marijuana impacts mood in bipolar disorder: A pilot study. Mental Health and Substance Use, 5, 228-239.

Sagar, Kelly A.; Dahlgren, M. Kathryn; Racine, Megan T.; Dreman, Meredith W.; Olson, David P.; Gruber, Staci A. (2016). Joint effects: A pilot investigation of the impact of bipolar disorder and marijuana use on cognitive function and mood. PLoS ONE, 11.

Wilson, Natascha; Cadet, Jean Lud. (2009). Comorbid mood, psychosis, and marijuana abuse disorders: A theoretical review. Journal of Addictive Diseases, 28, 309-319.

Footnotes:

1. Notice, too, that the researchers are looking at recreational marijuana use and not medically-prescribed marijuana use. That’s because whether you get your marijuana from a prescription pad or from a local, informal source, marijuana is largely the same. It is equally as powerful and going to have very similar effects when taken regularly. And because marijuana isn’t recognized by most practitioners as a legitimate treatment for depression symptoms, it’s hard to do research on it.
2. It could be that those in poorer physical health need medical marijuana to help alleviate a chronic pain or other health condition.

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How to Cope with Shame

A salesman started seeing psychotherapist Greg Struve, LAC, SEP, because he feared he was getting fired from his current position. The fear was legitimate: He’d been there for almost 18 months—the same time it’d take for him to get fired from previous jobs. Initially, when he’d start a new job, Struve’s client would work incredibly hard. After 6 months, however, he’d become terrified that his boss and coworkers didn’t like him and might even be trying to sabotage him. He’d start ruining these relationships and making major mistakes. And then, inevitably, he’d be fired.

Unconscious self-sabotage is a common symptom of shame, Struve said. “I’ve seen many clients with a long-standing pattern of making big mistakes at just the wrong time to prevent themselves from achieving something that they unconsciously don’t feel worthy of.”

Trauma therapist Britt Frank, LCSW, SEP, worked with a client who had profound shame about her sexual assault. “She told herself that she ‘should have fought back,’ and ‘should have tried to get away.’ [She] was sitting in a deep pool of depression as a result of the shame,” said Frank, who has a private practice in Kansas City.

Another client struggled with profound shame over her drug addiction. She felt shame (and guilt) for the pain she’d caused her family. And this shame would reignite a cycle of addiction and relapse.

Shame comes in all shapes and stripes. Shame can reside in everyday occurrences. In a conversation with our spouse. During a work meeting. During a class. At the gym. It manifests as people pleasing or chasing perfection.

However, what underlies different shame-filled situations is the same: The belief that we are unworthy. “Shame is a pervasive sense of ‘I am a mistake, and if people knew me they would reject me,’” said Frank, a certified somatic experiencing practitioner and an adjunct professor at the University of Kansas.

Shame is thinking: There is something fundamentally wrong with me. I am defective. I am damaged goods.

Shame is universal and has the same physiological sensations, Frank said: “a pit in the stomach, a feeling of weight on the shoulders, a red face, an inability to look people in the eye, and a desire to isolate and hide from the world.” Shame also triggers a state of survival physiology that spikes stress and shrinks our capacity to function, she said.

A lot of us create a “persona” to mask our shame, said Struve, who offers therapy sessions via online video at GregStruve.com, and serves as executive director of The Way Recovery, a Christ-based therapy clinic and IOP in Phoenix, Ariz. “We do what we can to project an image that will make us worthy of belonging in this world—making lots of money, becoming more attractive, being more religious, becoming an activist, trying to be famous… the list goes on.”

(According to Struve, “The way to decide if your motivation for wanting excellence is rooted in shame is simply to ask yourself: Do I believe that once I achieve this goal I’ll feel good enough? Is my goal to become excellent or to become worthy?”)

Shame stops us from being fully, authentically ourselves, because it convinces us that the true, at-the-core, us will just get rejected, he said. “For the primitive brain rejection equals death.” Shame isolates us, Frank said.

It’s also a vicious cycle. “When people feel shame, they turn to unhealthy coping behaviors to distract from the shame. These behaviors, once completed, end up producing even more shame, so the cycle continues.”

Even though it doesn’t feel like it, shame actually isn’t bad, Struve said. Shame has helped us survive for thousands of years. “A human being who was rejected from their tribe would find themselves at the mercy of the elements, predatory animals and, perhaps most dangerous, other people.”

The key is to work through your shame. While this is best done with a mental health professional, you can start with these suggestions:

Find an empathic person. According to Frank, “When people are locked in a shame spiral, the subcortical parts of the brain tend to take over, and logic and reason become difficult to access.” The part of the brain that’s wounded doesn’t think rationally. Which is why “to heal from shame, it is crucial to be connected in relationships to people who have the capacity to provide empathy.”

Create a collage. Struve suggested gathering a handful of magazines, and cutting out images that represent the parts of you that are hiding beneath your shame. Tape the cut-outs to a large piece of tag board, and hang it somewhere visible. “The reason this works so well is because your unconscious mind deals primarily in pictures, not in words. Simply noticing the collage on a daily basis allows it to go to work.”

Use compassionate self-talk. Frank and Struve both stressed the importance of using affirmations. Frank shared these examples: “I made a mistake, but I am still a good person. I am lovable and acceptable, and I can learn from my mistakes.” “I did not make good choices, but I am still worthy of love and acceptance, and I can make changes that can help enable better choices.” “I have the right to exist, even if I am not perfect.” She also suggested talking to ourselves like we would to a child.

Similarly, Struve talked about identifying limiting beliefs and regularly telling ourselves the opposite. To help you pinpoint limiting beliefs, look for patterns of difficulty in your life, he said. For instance, if you pick partners who cheat on you, your limiting belief might be: “I don’t deserve relationships with people who love me for me”; “all men/women cheat;” or “Sooner or later, I get betrayed.” So you’d tell yourself, “My life is filled with women/men who love and respect me and who behave honorably in relationships.” (You also might make a list of your ideal partner’s traits, he said.)

Use your senses. “Experiencing sensations can stimulate the parasympathetic nervous system, which is responsible for producing calmness and a sense of overall well-being,” Frank said. For instance, smell essential oils, listen to music and take a walk in nature, she said. What other ways can you appeal to your senses?

Forgive yourself. Self-forgiveness is speaking to ourselves with kindness and practicing self-acceptance. Which means accepting ourselves exactly as we are, and loving ourselves enough to keep growing, Frank said. If we’ve hurt someone, it also means “making amends, taking ownership over our mistakes, and doing our best to repair what we can.”

Shame is painful, and it can feel permanent. Thankfully, it isn’t. Again, you can work through it (on your own or with a therapist).

Struve’s client ended up changing his ways after doing somatic experiencing around his belief that his father didn’t want him as a child. “His difficulties at work subsided and he was able to focus on his performance and get it back on track.”

Frank’s client who struggled with her sexual assault started making peace with her body, particularly after understanding that the “freeze” response is one way our bodies keep us alive. Her client who struggled with addiction found healing through understanding the dynamics of addiction, receiving acceptance from her peers, starting to forgive herself and changing her shame-soaked self-talk.

No matter how deep or severe your shame, you can be free of it.

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My Depression Is a Voice in My Head

I’ve had depression for a very very long time but lately it has escalated. I’ve been suicidal for quite a while but now my thoughts aren’t my own. they’re like a separate voice in my head. instead of my own thinking it’s a whole other voice I can’t control. it says the only way it will go away is if I’m hurting myself. I have been clean for a month so I don’t want to but it’s not even my own thought. I don’t know if this is a sign of early schizophrenia or not.

A. You mentioned hearing a voice that is not your own. I wonder how you know it is not your voice. Voices fall under the category of hallucinations. Hallucinations are symptoms of psychotic disorders, one of which is schizophrenia. Hallucinations may also be the result of drug use or interactions, disorders such as epilepsy and other organic brain conditions. I cannot determine over the Internet if you have schizophrenia or any other mental health disorder.

When you believe that something may be wrong, then you should seek help. Thoughts of suicide are especially concerning and need to be taken seriously. Thus, it’s imperative that you contact a mental health professional for an evaluation.

Ask your parents to take you to a mental health professional. Another option is to contact the school guidance counselor. They will be able to help you. If you feel like you might harm yourself or someone else, go to the emergency room or call 911. They will be able to keep you safe and in touch with people who can help.

Your symptoms are highly treatable. Mental health professionals are trained to deal with every problem that you have described. It will not shock them and they will know how to respond. Medication and psychotherapy are good treatments that will provide a great deal of relief. I hope you get to experience treatment so you can see for yourself how much better you will feel. Treatment works. Please ask for it. Good luck.

Dr. Kristina Randle

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My Depression Is a Voice in My Head

I’ve had depression for a very very long time but lately it has escalated. I’ve been suicidal for quite a while but now my thoughts aren’t my own. they’re like a separate voice in my head. instead of my own thinking it’s a whole other voice I can’t control. it says the only way it will go away is if I’m hurting myself. I have been clean for a month so I don’t want to but it’s not even my own thought. I don’t know if this is a sign of early schizophrenia or not.

A. You mentioned hearing a voice that is not your own. I wonder how you know it is not your voice. Voices fall under the category of hallucinations. Hallucinations are symptoms of psychotic disorders, one of which is schizophrenia. Hallucinations may also be the result of drug use or interactions, disorders such as epilepsy and other organic brain conditions. I cannot determine over the Internet if you have schizophrenia or any other mental health disorder.

When you believe that something may be wrong, then you should seek help. Thoughts of suicide are especially concerning and need to be taken seriously. Thus, it’s imperative that you contact a mental health professional for an evaluation.

Ask your parents to take you to a mental health professional. Another option is to contact the school guidance counselor. They will be able to help you. If you feel like you might harm yourself or someone else, go to the emergency room or call 911. They will be able to keep you safe and in touch with people who can help.

Your symptoms are highly treatable. Mental health professionals are trained to deal with every problem that you have described. It will not shock them and they will know how to respond. Medication and psychotherapy are good treatments that will provide a great deal of relief. I hope you get to experience treatment so you can see for yourself how much better you will feel. Treatment works. Please ask for it. Good luck.

Dr. Kristina Randle

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Best of Our Blogs: September 29, 2017

There are devastating things happening in the world today.

Can we find paths to peace when everything feels like it’s falling apart?

When I was a kid, I thought money was evil. It did crazy things to people-made them jealous, angry and do unethical things. All I wanted was to save the world. As an adult, I realized I can’t save anyone unless I first take care of myself.

The same goes for the state of the world today. In order to have the energy, compassion and passion to extend outwards, we need to make sure we’re seeking support and restoration for ourselves.

This week, I hope you find time to read our articles. It’ll provide help if you’re being manipulated or alienated by others. And the next time you feel stuck or anxious, you might want to try doodling. One of our posts explains the benefits below.

9 Signs You Are Being Emotionally Controlled & How To Stop It
(Caregivers, Family & Friends) – What does an unpredictable friend, an emoticon enthusiast, and aggressive social media follower have in common? They may all be trying to control you.

Parental Alienation-Perhaps a Step-Mom, But Never a Mom
(Full Heart, Empty Arms) – It’s a surprising thing that comes with step-motherhood you didn’t expect.

A Narcissist’s Hidden Shame
(The Exhausted Woman) – Is their such thing as a happy ending for those with narcissistic personality disorder? Read this couple’s story to see what’s possible for someone with NPD.

7 Benefits of Doodling You Might Not Know
(Reaching Life Goals) – If you find yourself doodling during a meeting, save your guilt. It may help solve your next work problem.

Can You Be Friends With A Sociopath?
(Tales of Manic Depression) – Here’s what happens when you go from friends to romantic relationship with a sociopath.

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